NR 565 (Advanced Pharmacology) Midterm
Questions and Answers (2026/2027) |
Updated Review | A+ Verified
• benefits of full practice authority -✓✓Nurse practitioners have the autonomy to
evaluate patients, diagnose, order and interpret tests, initiate and manage
treatments and prescribe medications, including controlled substances without
physician oversight
• promoting positive outcomes through prudent prescribing practices -
✓✓Administering medications and prescribing medications are two distinct
processes. Prescription writing requires prudent and deliberate decision-making
processes to maintain patient safety and reduce liability, including:
*documentation of a provider-patient relationship for the recipient of the
prescribed medications
*documentation of a thorough history and physical examination for the recipient
*documentation of discussions regarding risk factors, side effects, or therapy
options
*documentation of drug monitoring or titration plan, if applicable
*documentation of consultations, if any
avoidance of prescribing medications for self, family, or friends
Rational drug selection requires a logical approach that includes the formulation of
a diagnosis based on clinical reasoning and the selection and monitoring of the
most appropriate pharmacological treatment
Considerations include: Cost, guidelines, availability, interactions, side effects,
allergies, hepatic/renal functions, need for monitoring, & special populations
• Beer's Criteria -✓✓identifies drugs with a high likelihood of causing adverse
effects in older adults. Accordingly, drugs on this list should generally be avoided
,in adults older than 65 years except when the benefits are significantly greater than
the risks.
• Pharmacodynamics -✓✓the study of the biochemical and physiologic effects of
drugs on the body and the molecular mechanisms by which those effects are
produced
• Pharmacokinetics -✓✓the study of drug movement throughout the body
• Pharmacogenomics -✓✓the study of how genes affect a person's response to
drugs. The purpose of this is to combine the sciences of genomics and
pharmacology to provide individualized, targeted, safe drug therapies to patients
• CYP450 inducers -✓✓Inducers are xenobiotics (medications and environmental
agents) that elevate CYP450 enzyme activity by increasing enzyme synthesis. This
action leads to additional sites available for biotransformation. The increased
number of sites enhances medication metabolism, decreasing the concentration of
the "parent drug" while increasing metabolite production.
Inducers = Increase medication metabolism
(Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin, Phenobarbital,
Sulfonylureas)
• CYP450 inhibitors -✓✓Inhibitors are medications that inhibit the metabolic
activity of one or more of the CYP450 enzymes. Medications that inhibit an
enzyme potentially slows that enzyme's activity or blocks the activity required for
the metabolism of other medications, thereby increasing the levels of medications
dependent on that particular enzyme for biotransformation. Inhibitors = decrease
medication metabolism (Valproate, Isoniazid, Sulfonamides, Amiodarone,
Chloramphenicol, Ketoconazole, Grapefruit Juice, Quinidine)
• cultural influences in prescribing -✓✓The greatest concern surrounding race-
based therapy has to do with genetic variability. We know there is great diversity
within and among racial groups; therefore, a "one fits all" approach based on race
is unwise. Still, we can use known associations to guide choices. For example,
differences in metabolism between people with East Asian and European heritage
are common. The provider can use this knowledge to guide initial dosing (with
,adjustment, as indicated based on response) if genetic testing is not feasible or
warranted
• Polypharmacy: Definition, challenges, and outcomes -✓✓treatment with
multiple drugs
greatly increases the risk for interactions. Some of these interactions are negligible,
but some can have life-threatening consequences. It is of crucial importance to ask
the patient about all current drugs, including over-the-counter (OTC) medications
and other herbal preparations. Many patients do not consider OTC or alternative
pharmaceuticals as "medications" and may not mention them unless you ask
specifically.
• Acute Pain Management -✓✓
• Chronic Pain Management -✓✓
• Opioid Management -✓✓
• Regulations of Controlled Substances -✓✓The U.S. Department of Justice Drug
Enforcement Agency (DEA) coordinates with local, state, and federal agents to
reduce illicit drug use. The DEA enacted the Controlled Substances Act (CSA) in
1970 to regulate drugs and other substances based on their potential for abuse and
dependency. Five schedules of controlled substances were created that are updated
annually. Classes of scheduled substances include narcotics, depressants,
stimulants, hallucinogens, and anabolic steroids. The DEA issues eligible providers
with a registration number to write prescriptions for controlled substances.
Characteristics of a valid DEA number include:
-The first letter identifies the type of provider: A=before 1985; B=after 1985;
F=after 2007; M=nurse practitioner or physician assistant
-The 2nd letter the 1st letter of the provider's last name at the time of initial
registration
Example: Tammy Greene applies for and receives a DEA number of MG2705208
M=nurse practitioner and G=Greene
• Opioid Epidemic & Responsible Prescribing -✓✓
, • Opioid Use Disorder -✓✓a pattern of use that leads to significant impairment or
distress. Typically, this disorder is marked by unsuccessful efforts to reduce or
control use resulting in the inability to fulfill work, school, or home
responsibilities. Opioid use disorder is different from drug tolerance and physical
dependence, which may also exist. Opioid use creates high levels of positive
reinforcement, increasing the likelihood of continued use. It is often a chronic
lifelong disorder, leading to serious consequences such as disability and death.
Although it is similar to other substance use disorders, it has distinct features that
have fueled the current opioid epidemic. Opioids can lead to physical dependence
in only 4-8 weeks. Abruptly stopping use in chronic users leads to severe
symptoms, which motivates continued use to prevent withdrawal. The 2016 CDC
guidelines for prescribing opioids recommends calculating the total daily dose of
opioids to help identify patients who might benefit from the reduction or tapering
of opioids, given the risk of overdose
• State Prescription Drug -✓✓Clinicians should review the patient's history of
controlled substance prescriptions using state prescription drug monitoring
program (PDMP) data to determine whether the patient is receiving opioid dosages
or dangerous combinations that put him or her at high risk for overdose. Clinicians
should review PDMP data when starting opioid therapy for chronic pain and
periodically during opioid therapy for chronic pain, ranging from every
prescription to every 3 months.
• Monitoring Programs -✓✓safeguards to address the opioid public health crisis
include prescription drug monitoring programs (PDMPs). These electronic
databases enable providers to access information regarding a patient's prescription
history of controlled substances. Nearly all states have implemented PDMPs, and
some states require providers to check the PDMP before prescribing controlled
substances. According to the CDC (2020), PDMPs have shown promising results
in changing prescribing behaviors, decreasing the use of multiple providers by
patients, and decreasing substance abuse treatment admissions.
• Drug Schedules -✓✓Each drug preparation regulated under the CSA has been
assigned to one of five categories: schedule I, II, III, IV, or V. Drugs in schedule I
have a high potential for abuse and no approved medical use in the United States.
In contrast, drugs in schedules II through V all have approved applications.
Assignment to schedules II through V is based on abuse potential and potential for
causing physical or psychological dependence. Of the drugs that have medical
applications, those in schedule II have the highest potential for abuse and
Questions and Answers (2026/2027) |
Updated Review | A+ Verified
• benefits of full practice authority -✓✓Nurse practitioners have the autonomy to
evaluate patients, diagnose, order and interpret tests, initiate and manage
treatments and prescribe medications, including controlled substances without
physician oversight
• promoting positive outcomes through prudent prescribing practices -
✓✓Administering medications and prescribing medications are two distinct
processes. Prescription writing requires prudent and deliberate decision-making
processes to maintain patient safety and reduce liability, including:
*documentation of a provider-patient relationship for the recipient of the
prescribed medications
*documentation of a thorough history and physical examination for the recipient
*documentation of discussions regarding risk factors, side effects, or therapy
options
*documentation of drug monitoring or titration plan, if applicable
*documentation of consultations, if any
avoidance of prescribing medications for self, family, or friends
Rational drug selection requires a logical approach that includes the formulation of
a diagnosis based on clinical reasoning and the selection and monitoring of the
most appropriate pharmacological treatment
Considerations include: Cost, guidelines, availability, interactions, side effects,
allergies, hepatic/renal functions, need for monitoring, & special populations
• Beer's Criteria -✓✓identifies drugs with a high likelihood of causing adverse
effects in older adults. Accordingly, drugs on this list should generally be avoided
,in adults older than 65 years except when the benefits are significantly greater than
the risks.
• Pharmacodynamics -✓✓the study of the biochemical and physiologic effects of
drugs on the body and the molecular mechanisms by which those effects are
produced
• Pharmacokinetics -✓✓the study of drug movement throughout the body
• Pharmacogenomics -✓✓the study of how genes affect a person's response to
drugs. The purpose of this is to combine the sciences of genomics and
pharmacology to provide individualized, targeted, safe drug therapies to patients
• CYP450 inducers -✓✓Inducers are xenobiotics (medications and environmental
agents) that elevate CYP450 enzyme activity by increasing enzyme synthesis. This
action leads to additional sites available for biotransformation. The increased
number of sites enhances medication metabolism, decreasing the concentration of
the "parent drug" while increasing metabolite production.
Inducers = Increase medication metabolism
(Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin, Phenobarbital,
Sulfonylureas)
• CYP450 inhibitors -✓✓Inhibitors are medications that inhibit the metabolic
activity of one or more of the CYP450 enzymes. Medications that inhibit an
enzyme potentially slows that enzyme's activity or blocks the activity required for
the metabolism of other medications, thereby increasing the levels of medications
dependent on that particular enzyme for biotransformation. Inhibitors = decrease
medication metabolism (Valproate, Isoniazid, Sulfonamides, Amiodarone,
Chloramphenicol, Ketoconazole, Grapefruit Juice, Quinidine)
• cultural influences in prescribing -✓✓The greatest concern surrounding race-
based therapy has to do with genetic variability. We know there is great diversity
within and among racial groups; therefore, a "one fits all" approach based on race
is unwise. Still, we can use known associations to guide choices. For example,
differences in metabolism between people with East Asian and European heritage
are common. The provider can use this knowledge to guide initial dosing (with
,adjustment, as indicated based on response) if genetic testing is not feasible or
warranted
• Polypharmacy: Definition, challenges, and outcomes -✓✓treatment with
multiple drugs
greatly increases the risk for interactions. Some of these interactions are negligible,
but some can have life-threatening consequences. It is of crucial importance to ask
the patient about all current drugs, including over-the-counter (OTC) medications
and other herbal preparations. Many patients do not consider OTC or alternative
pharmaceuticals as "medications" and may not mention them unless you ask
specifically.
• Acute Pain Management -✓✓
• Chronic Pain Management -✓✓
• Opioid Management -✓✓
• Regulations of Controlled Substances -✓✓The U.S. Department of Justice Drug
Enforcement Agency (DEA) coordinates with local, state, and federal agents to
reduce illicit drug use. The DEA enacted the Controlled Substances Act (CSA) in
1970 to regulate drugs and other substances based on their potential for abuse and
dependency. Five schedules of controlled substances were created that are updated
annually. Classes of scheduled substances include narcotics, depressants,
stimulants, hallucinogens, and anabolic steroids. The DEA issues eligible providers
with a registration number to write prescriptions for controlled substances.
Characteristics of a valid DEA number include:
-The first letter identifies the type of provider: A=before 1985; B=after 1985;
F=after 2007; M=nurse practitioner or physician assistant
-The 2nd letter the 1st letter of the provider's last name at the time of initial
registration
Example: Tammy Greene applies for and receives a DEA number of MG2705208
M=nurse practitioner and G=Greene
• Opioid Epidemic & Responsible Prescribing -✓✓
, • Opioid Use Disorder -✓✓a pattern of use that leads to significant impairment or
distress. Typically, this disorder is marked by unsuccessful efforts to reduce or
control use resulting in the inability to fulfill work, school, or home
responsibilities. Opioid use disorder is different from drug tolerance and physical
dependence, which may also exist. Opioid use creates high levels of positive
reinforcement, increasing the likelihood of continued use. It is often a chronic
lifelong disorder, leading to serious consequences such as disability and death.
Although it is similar to other substance use disorders, it has distinct features that
have fueled the current opioid epidemic. Opioids can lead to physical dependence
in only 4-8 weeks. Abruptly stopping use in chronic users leads to severe
symptoms, which motivates continued use to prevent withdrawal. The 2016 CDC
guidelines for prescribing opioids recommends calculating the total daily dose of
opioids to help identify patients who might benefit from the reduction or tapering
of opioids, given the risk of overdose
• State Prescription Drug -✓✓Clinicians should review the patient's history of
controlled substance prescriptions using state prescription drug monitoring
program (PDMP) data to determine whether the patient is receiving opioid dosages
or dangerous combinations that put him or her at high risk for overdose. Clinicians
should review PDMP data when starting opioid therapy for chronic pain and
periodically during opioid therapy for chronic pain, ranging from every
prescription to every 3 months.
• Monitoring Programs -✓✓safeguards to address the opioid public health crisis
include prescription drug monitoring programs (PDMPs). These electronic
databases enable providers to access information regarding a patient's prescription
history of controlled substances. Nearly all states have implemented PDMPs, and
some states require providers to check the PDMP before prescribing controlled
substances. According to the CDC (2020), PDMPs have shown promising results
in changing prescribing behaviors, decreasing the use of multiple providers by
patients, and decreasing substance abuse treatment admissions.
• Drug Schedules -✓✓Each drug preparation regulated under the CSA has been
assigned to one of five categories: schedule I, II, III, IV, or V. Drugs in schedule I
have a high potential for abuse and no approved medical use in the United States.
In contrast, drugs in schedules II through V all have approved applications.
Assignment to schedules II through V is based on abuse potential and potential for
causing physical or psychological dependence. Of the drugs that have medical
applications, those in schedule II have the highest potential for abuse and
